| NPI | 1104027325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 42929) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301083431) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2016-03-23 |